Aged care reforms an important step in the right direction, but many questions and concerns remain

The Federal Government’s aged care reforms seem to have met a generally positive response, but “a long and uncertain road” lies ahead, cautions Hal Kendig, a Research Professor of Ageing and Health at the University of Sydney.

In the article below, first published by The Conversation, he outlines some of the critical challenges and concerns about the future of aged care.

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Some of the issues to watch

Hal Kendig writes:

The Government’s aged care reforms are a landmark for setting valuable directions for better care. It’s the first such major initiative in more than 25 years – but there’s a long and uncertain road ahead.

The reforms outlined in the Living Longer Living Better report align with important values about what older people (and their carers) want – to stay in their own homes for as long as possible.

There’s an emphasis on a fairer, more accountable, and more sustainable financial system. Inconsistencies in existing funding arrangements will be addressed and consumer protections strengthened. And the proposed Gateway and My Aged Care Website service have potential to improve transparency and access to services.

The favourable reception so far, from consumers and providers alike, reflect sound policy work by the Productivity Commission, attentive consultation by the Minister and Council on the Ageing, and astute political judgements by the minority Gillard government.

Missing nuts and bolts

But – and there are many big “buts” here – substantial commitments have yet to be achieved. Only baby steps have been outlined in terms of genuinely new public funding, with most foreshadowed increases deferred for years.

New initiatives are to be paid for mainly through increased user charges and tighter means tests, redirection of existing funds, and re-worked funding formulae. There appears to be little risk of a major consumer backlash as, once again, the family home remains sacrosanct.

But while the principles and directions are strong, one might well ask “how will this actually happen?”

It’ll probably take the planned ten-year timetable to fundamentally reorient the aged care system. And we have to remember that the ten-year implementation that occurred the last time we had reform in aged care, from the mid-1980s to mid-1990s, was done under one political administration – Labor. And this government’s future – in terms of political control and leadership and economic prospects and funding contexts – is less than clear.

The focus on people with dementia recognises their special needs and community concern. We’d hope that comparable resources and sensitivity could also be directed to those with intense and complex needs on the basis of other social, cultural, and health vulnerabilities.

Community care

The new Commonwealth Home Support Program promises to better integrate and increase flexibility in providing assistance at home, carer support and respite. The new Home Care Packages would provide more options for higher-level support in the community along with a wider range of flexible consumer-directed care.

It’s disappointing that there hasn’t been a more fundamental funding redirection toward community care – although there are cost pressures on the residential care industry. Nor is there much indication that services will be developed and delivered at a more regional level where they can be better coordinated. That sort of redirecting is going to be a tough nut to crack and it’s going to take a lot of effort.

The bigger picture is that the directions of the reforms are sensible but still have the hallmarks of control out of central offices in Canberra. And there’s scant attention to the need for better accommodation options in the community and for more integration of aged care with health care and health promotion.

Fundamental change – not incremental program developments – is needed to get aged care focused on what older individuals and their carers really want and where they live.

Nonetheless, here are the beginnings of a necessary turn-around toward a fundamental transformation from a funding-driven, provider-driven system to one that’s driven by what older people themselves need and want. And toward how to improve the health and well-being of older people, as well as their care. Although we don’t see much way ahead on specifics as yet, you have to start with the vision, with purposes and principles and then directions.

Residential aged care

The funds given to residential care in the package are fundamentally band aids for the hole we’re in right now. That’s very understandable because it’s very difficult to provide quality care for people with high levels of need, and many residential-care providers are pressured in this regard.

But while attending to this short-term crisis, we have to make sure we don’t lock into ongoing support for high-level care only in a residential context. That’s not what older people want, and it’s not necessarily the best way of doing it. It could be a self perpetuating policy approach.

We’re going to have to work hard to enable us to really make a break and move with the new system, albeit without abandoning the good providers and the older people in care now.

Means testing

The proposed means testing is actually quite gentle at this point. There’s no way older people will be forced out of their homes in order to pay for residential care or aged care of any kind. That’s not going to happen.

If these recommendations are fully implemented, older people with the financial means would make sensible and fair contributions in a variety of ways towards the cost, especially the capital cost, of their care.

This is a necessary reform that could enable more resources to be available for those in very high levels of need. And it would limit the financial pressures on the next generation, many of whom do not have the same kind of wealth that some older people have when moving into residential care.

So this means-testing and shared funding responsibility is fundamental to refocusing the aged care system to equitably meeting our basic principles. It’s important that we use the co-contributions to improve access to quality accommodation and care for older people without means, rather than to achieve surpluses or reduce taxes.

Workforce

It’s surprising to see how large the amount of money dedicated to the aged care workforce are. It makes me wonder how they’d be paid for, from savings within existing programs while maintaining levels and quality of care. Good education and training are essential, of course, but there are risks if central directives lock in work practices that aren’t meeting care needs in the most cost-effective ways.

The Productivity Commission’s approach was to adequately fund and require good quality care, leaving providers to work out the best ways ahead within these quality and cost controls.

Reforming aged care in Australia

This is the most encouraging direction we’ve had in aged care for two decades. The Government’s response is based on fundamentally important analyses and we’ll need real public will and political will to take the next steps. It will be worth it.

Expectations for care certainly are increasing for the next generation of older people. And there will be some modest increase of financial capabilities for some but your aspirations when you’re in your 50s and 60s about old age are likely to be very different once you’re in your 80s and very dependent, very frail.

Everyone wants to feel secure, comfortable and respected in advanced old age. The best way to plan for this is to have good health promotion and economic security in mid-life and to get the care system right for vulnerable people who are already in their old age.

• Professor Kendig is a Research Professor of Ageing and Health at the University of Sydney where he heads the Ageing, Work, and Health Research Unit in the Faculty of Health Sciences. As a gerontologist and sociologist he has expertise in longitudinal survey research, health behaviours, socio-economic resources, housing and health and community care services and policies.

About this blog

The Croakey blog is a forum for debate and discussion about health issues and policy. It is moderated by Melissa Sweet, a freelance journalist with a personal and professional bent towards public health perspectives. Regular contributors include members of the Crikey Health and Medical Panel.